[Use of liquid perfluorocarbons in vitrectomy for difficult cases of proliferative diabetic retinopathy]

Thanks to their physical properties, could perfluorocarbon liquids (PFCL) be useful during vitrectomy for severe cases of proliferative diabetic vitreo-retinopathy (PDVR)?

Among 120 vitrectomies for PDVR performed in a period of time from August 1992 to July 1993, we reviewed 24 cases with a minimal follow-up of six months for which we have used PFCL as intraoperative tool. Among these eyes, three (12%) were preoperatively attached, seven (29%) presented with a tractional retinal detachment sparing the macular area and 14 (59%) with a retinal detachment involving the macula. The indication for PFCL injection was either to flatten the retina in case of iatrogenic tear or retinotomy (15/24 eyes) or to stop a bleeding coming from the optic disc (9/24). The aim was to allow a good laser endophotocoagulation in all the cases and to inject an intraocular tamponade on a reattached retina if needed. As final tamponade, silicone oil was used in 10 eyes, gas in nine eyes and none in five eyes.

At the end of the study, 20 (83%) eyes had a totally reattached retina and four (17%) a detached retina. The postoperative compared to the preoperative visual acuity was improved in 13 eyes (54%), unchanged in seven eyes (30%) and decreased in four eyes (16%). In one case (4%), some droplets of PFCL were noticed in the vitreous cavity, under the silicone oil bubble, with a good clinical tolerance. No specific complication of PFCL injection could be found in the 23 other eyes.

In some selected cases of severe PDVR, the use of PFCL may help to flatten the retina, to stop bleeding from the optic disc and to perform a good endolaser photocoagulation. This allows to achieve good anatomical and visual results with few specific complications.